WHO launched a global campaign urging governments to adopt a tool to reduce the spread of antimicrobial resistance, adverse events and costs.
The AWaRe tool was developed by the WHO Essential Medicines List to contain rising resistance and make antibiotic use safer and more effective. It classifies antibiotics into three groups – Access, Watch and Reserve – and specifies which antibiotics to use for the most common and serious infections, which ones should be available at all times in the healthcare system, and those that must be used sparingly or preserved and used only as a last resort.
The new campaign aims to increase the proportion of global consumption of antibiotics in the Access group to at least 60%, and to reduce use of the antibiotics most at risk of resistance from the Watch and Reserve groups. Using Access antibiotics lowers the risk of resistance because they are ‘narrow-spectrum’ antibiotics (that target a specific microorganism rather than several). They are also less costly because they are available in generic formulations.
One of the most pressing concerns is the spread of resistant gram-negative bacteria, including Acinetobacter, Escherichia coli and Klebsiella pneumoniae. These bacteria, which are commonly seen in hospitalized patients, cause infections like pneumonia, bloodstream infections, wound or surgical site infections and meningitis. When antibiotics stop working effectively, more expensive treatments and hospital admissions are needed, taking a heavy toll on already stretched health budgets.
At the same time, many low- and middle-income countries experience vast gaps in access to effective and appropriate antibiotics. Childhood deaths due to pneumonia (estimated globally at close to one million per year) because of lack of access to antibiotics remain frequent in many parts of the world. And although over 100 countries have put in place national plans to tackle antimicrobial resistance, only about one fifth of those plans are funded and implemented.
“Tackling antimicrobial resistance requires a careful balance between access and preservation,” said Dr Hanan Balkhy, WHO Assistant-Director General for antimicrobial resistance. “The AWaRe tool can guide policy to ensure patients keep being treated, while also limiting use of the antibiotics most at risk of resistance.”
In the absence of new significant investments into the development of new antibiotics, improving the use of antibiotics is one of the key actions needed to curb further emergence and spread of antimicrobial resistance. By classifying antibiotics into three distinct groups, and advising on when to use them, AWaRe makes it easier for policy-makers, prescribers and health workers to select the right antibiotic at the right time, and to protect endangered antibiotics.
